Community and Rural: Docs Wanted

For more analysis and a look at the complete survey results from all sectors, please visit our HealthLeaders Media Industry Survey 2009Web page, which features downloadable reports covering CEOs, finance, technology, quality, marketing, health plan, physician, and community and rural leaders.

The physician shortage and associated recruiting difficulties are negatively affecting healthcare delivery all over the United States. But the challenge is particularly acute in rural areas. More than 47% of CEOs at rural healthcare organizations surveyed by HealthLeaders Media say the physician shortage is having a "strongly negative" impact on their operations, compared with 25.3% of CEOs in nonrural areas.

Alan Morgan, CEO of the National Rural Health Association, says rural hospitals' physician recruiting problem is built into the system. "It has a lot to do with how we train physicians," Morgan says. "We get the best and brightest from urban areas and we train them in urban areas. It's just really, really tough to find someone from New York City and expect them to want to practice in Flush, KS."

Sandy Haryasz, CEO of Banner Page Hospital, a 25-bed critical-access hospital in Page, AZ, says there is also a more insidious reason why physicians don't want to come to the country. "Spouse! The No. 1 thing is that the physician wants to come but the spouse doesn't because we are rural," Haryasz says. "There's not enough shopping, or entertainment, or social life. Generally, if we have any interest expressed whatsoever, we have to win the spouse over."

In the survey, nearly 37% of rural physicians who are attempting to recruit colleagues for their practice or hospital listed "our location isn't appealing to physicians" as their No. 1 biggest recruiting challenge, while only 10.4% of non-rural physician recruiters listed that as a major obstacle.

City hospitals have their own problems attracting physicians. Nearly 48% of nonrural physician leaders say their biggest obstacle is meeting physician compensation demands, while 29% say it is finding qualified candidates.

What is particularly alarming, both in urban and rural areas, is the four in 10 physicians who say they would not recommend a medical career to their children. Among the factors discouraging physicians are a lack of family time or a personal life, paperwork hassles, and too many professional compromises. Morgan says many of those frustrations are exacerbated at rural healthcare facilities, where doctors often don't have the office assistants to help them with paperwork and where they are expected to be on call. "In fact, you are never off duty as a rural clinician," Morgan says.

As hard as it is now to find a doctor, it could get tougher in the near future, especially in the rural setting. When asked what financial strategies they expect to implement over the next three years, 22.5% of rural physicians say they will stop taking call (compared with just 10.7% nonrural). And while being a CEO of a rural hospital may provide the same challenges as larger, nonrural hospitals, it doesn't provide the same pay. Our survey found that nearly 46% of nonrural hospital CEOs made $250,000 or more a year, while only about 16% of their rural colleagues were in the same earnings bracket.

Morgan says rural CEOs are often the victims of small-town groupthink. "In rural communities everyone knows what everyone makes," he says. "It is awfully hard for a board in a rural community to justify an outrageous salary for someone they are going to see in the grocery store and at church. Rural areas seem to place a better check and balance on the salaries of their CEOs."

Although they may be paid less, Morgan says rural CEOs continually surprise him with their ability to handle a wide array of tasks. "A rural CEO has his sleeves rolled up and engaged on why the new IT system doesn't work. They are acutely attuned to Medicare/Medicaid reimbursement issues," he says. "When I'm at meeting with rural and urban hospital CEOs, they all have the same challenges and issues they face. But whereas the urbans can delegate a lot of the minutia, the rurals really have to get into the weeds."